Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation

Unoki, Takeshi; Grap, Mary Jo; Sessler, Curtis N.; Best, Al M.; Wetzel, Paul; Hamilton, Anne; Mellott, Karen G.; Munro, Cindy L.

doi:10.4037/ajcc2009509

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Pulmonary Critical Care| January 01 2009

Autonomic Nervous System Function and Depth of Sedation in Adults Receiving Mechanical Ventilation

Takeshi Unoki, RN, PhD;

Takeshi Unoki, RN, PhD

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Mary Jo Grap, RN, PhD, ACNP;

Mary Jo Grap, RN, PhD, ACNP

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Curtis N. Sessler, MD;

Curtis N. Sessler, MD

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Al M. Best, PhD;

Al M. Best, PhD

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Paul Wetzel, PhD;

Paul Wetzel, PhD

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Anne Hamilton, MS, RN, FNP;

Anne Hamilton, MS, RN, FNP

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Karen G. Mellott, RN, MS;

Karen G. Mellott, RN, MS

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Cindy L. Munro, RN, PhD, ANP

Takeshi Unoki is a senior assistant professor in the Department of Adult Nursing, School of Nursing, St Luke’s College of Nursing, Tokyo, Japan. Mary Jo Grap and Cindy L. Munro are professors, Anne Hamilton is a PhD student, and Karen G. Mellott is a doctoral candidate in the School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Curtis N. Sessler is a professor and Al M. Best is an associate professor in the Department of Internal Medicine and the Biostatistics Department, School of Medicine, and Paul Wetzel is an associate professor in the Biomedical Engineering Department, School of Engineering, at Virginia Commonwealth University.

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Am J Crit Care (2009) 18 (1): 42–51.

https://doi.org/10.4037/ajcc2009509

Background The effect of the depth of sedation on the function of the autonomic nervous system is not well known.

Objectives To describe the effect of level of sedation on heart rate variability as a marker of the function of the autonomic nervous system in patients receiving mechanical ventilation.

Methods This pilot study was part of a larger study in which sedation level was measured continuously for up to 24 hours. The sample consisted of 14 patients receiving mechanical ventilation. The R-R interval was measured continuously via electrocardiography. Sedation level was determined by using the Patient State Index and was categorized as deep (<60) or light (=60). Continuous heart rate data of 5 to 10 minutes for each sedation level for each patient were analyzed.

Results Parasympathetic activity as indicated by root mean square of successive difference of the R-R interval, the high-frequency component, and the percentage of differences of successive N-N intervals (intervals due to normal sinus depolarization) that differed more than 50 milliseconds was significantly lower for deep sedation than for light sedation. The markers indicating sympathetic activity, including the low-frequency component and the ratio of the low-frequency component to the high-frequency component, did not differ significantly between the 2 levels of sedation. Most patients were receiving benzodiazepines.

Conclusions Deep sedation may be associated with depression of parasympathetic function in patients receiving mechanical ventilation. Use of benzodiazepines most likely contributed to this finding.

2009

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